MSCT重建技术在胰腺癌术前评估中的应用

Utility of MSCT reconstruction in preoperative evaluation of pancreatic carcinoma

目的 探讨多层螺旋CT（MSCT）重建技术在胰腺癌手术可切除性评估中的应用价值.方法 回顾性分析35例经手术证实的胰腺癌患者的多期增强CT图像及包括容积重建（VR）、多平面重建（MPR）、曲面重建（CPR）等的后处理方法,重点观察胰腺肿瘤与周围结构、邻近血管、胆管的关系,进行肿瘤能否手术切除的评估,并与实际手术的结果进行对比.结果 35例患者中9例共27支血管受侵犯;19例总胆管、12例胰管受侵犯;7例十二指肠受侵,2例胃后壁受侵,1例脾肿大伴区域性门脉高压;14例次胰头周围淋巴结肿大,4例次腹主动脉旁淋巴结肿大,3例肝转移.CT术前评估手术可切除21例,最终19例行胰腺癌根治术,2例行姑息术;术前评估手术不可切除14例,均行姑息术.根治术、姑息术术前评估与术后结果符合率分别为90％、88％.结论 MSCT重建技术能提高对胰腺癌局部侵犯、转移的诊断,可提高对肿瘤可切除性的评估.

Objective To investigate the value of multi slice spiral computed tomography （MSCT） reconstruction technique for diagnosis and preoperative evaluation of pancreatic carcinoma. Methods The multi - phase enhanced CT images of thirty - five cases of pancreatic carcinoma proved histologically were analyzed retrospectively. The techniques of volume rendering （VR）, multi-planar reconstruction （MPR） and curved planar reformation （CPR） were used to deal with the images, and the relation between the pancreatic tumor and its surrounding structures, vessels, bile duct were observed, then the evaluation of possible surgical resection was performed, then it was compared with operative results. Results Among the 35 patients, 27 vessels invasion was showed in 9 patients, common bile duct invasion in 19 patients, pancreatic duct invasion in 12 patients, duodenum invasion in 7 patients, posterior wall of stomach in 2 patients was invaded; one patient had regional portal hypertension with splenomegaly, peri-pancreatic lymph nodes enlargement was detected in 14 patients, para-aortic lymph nodes enlargement was detected in 4 patients, and liver metastasis was found in 3 patients. According to CT evaluation, surgery could be performed in 21 cases, finally 19 patients underwent curative pancreatic cancer resection, and 2 patients underwent palliative surgery. According to CT evaluation, surgery could not be performed in 14 cases, and all of the patients underwent palliative surgery. The coincidence percentage of pre-operative evaluation and post-operative results of curative surgery, palliative surgery was 90% and 88%. Conclusions MSCT reconstruction technique is useful for diagnosis of pancreatic carcinoma regional invasion and metastasis, and it can increase the accuracy of assessment of tumor resectability.